Patients with HIV can safely receive kidneys from deceased HIV-positive donors, with good five-year survival rates

HIV-positive patients can safely receive kidneys from deceased HIV-infected donors, investigators from South Africa report in the February 12th edition of the New England Journal of Medicine. Survival rates one, three and five years after transplantation were comparable to those observed in HIV-negative kidney transplant patients. HIV infection remained well controlled but infections were an important cause of death and hospitalisation.

“Our study showed that kidneys from HIV-positive deceased donors can be transplanted into carefully selected HIV-positive recipients, with the expectation that outcome would be similar to that observed in kidney transplantation programs involving high-risk patients without HIV infection,” comment the investigators. An accompanying editorial described the study’s outcomes as “impressive.”

Thanks to antiretroviral therapy many HIV-positive patients now have a near normal life expectancy. But even in the era of effective therapy, between 8% to 22% of HIV-positive patients receiving treatment have chronic kidney disease.

Previous research suggests that HIV-positive individuals doing well on antiretroviral therapy can have good outcomes and survival rates after kidney transplantation from HIV-negative donors.

Investigators from South Africa wanted to see if HIV-positive patients with end-stage kidney disease could safely receive kidneys from deceased donors who were also HIV-positive. The study was undertaken at the transplantation centre of the Groote Schuur Hospital in Cape Town. The policy of providing HIV-infected patients with kidneys from deceased HIV-positive individuals was initiated because HIV infection was considered a contraindication for the receipt of a donated organ. Although this policy changed in 2009, investigators continued to provide HIV-positive patients with kidneys donated by HIV-positive patients who had died. They monitored medium term survival rates in 27 patients who received kidneys between 2008 and 2014.